Treatment of Avascular Necrosis of the Femoral Head With Vascularized Fibular Transplant

Soucacos, Panayotis N.; Beris, Alexandros E.; Malizos, Konstantinos N.; Koropilias, Anastasios; Zalavras, Haralampos; Dailiana, Zoe

doi:10.1097/00003086-200105000-00016

Cited by 99 publications

(61 citation statements)

References 21 publications

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“…First, in reported outcomes after FVFG, precollapse and postcollapse femoral heads have been grouped together when plotting graft survival and identifying risk factors for failure [19,[22][23][24][25][26]28]. Stage, size, and etiology have been identified as factors influencing the likelihood of hip preservation after FVFG [16,22,28], but it is not known whether these hold true in the specific subset of patients treated before bony collapse.…”

Section: Introductionmentioning

confidence: 99%

The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

Eward

Rineer²,

Urbaniak

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Results Forty-nine of 65 hips (75%) had surviving FVFG for at least 10 years. At last followup, 39 of 65 hips (60%) had surviving FVFG, with a mean graft survival time of 15 years (range, 10.5-26.1 years). Twenty-six of the 65 hips with FVFG (40%) underwent conversion to THA at a mean of 8 years postoperatively. Demographic factors, lesion size, additional procedures, and low preoperative function were not associated with changes in graft survivorship. Pain and function were similar in patients with surviving FVFG and patients who had conversion to THA. Patients with surviving FVFG were more likely to engage in impact sports or active events than were patients who had conversion to THA. Conclusions When patients with precollapse ONFH undergo FVFG, the majority have preservation of the hip lasting for greater than 10 years with low levels of pain and reasonable function. In patients who ultimately undergo conversion surgery to THA, the mean duration of hip preservation before conversion is 8 years. We continue to use FVFG for treating patients younger than 50 years with symptomatic, precollapse ONFH. Level of Evidence Level IV, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.

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Section: Introductionmentioning

confidence: 99%

The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

Eward

Rineer²,

Urbaniak

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Conceptually, the best option is removal of the necrotic bone from the femoral head and replacement with a viable and structurally-sound bone, thus restoring vitality to the femoral head, preventing collapse of the articular surface, and delaying, THA, if prevention is unlikely. [10] Several surgical approaches to preserve the hip for treatment of ANFH have been described including core decompression, various osteotomies, bone grafting (vascularized or nonvascularized). Bone grafting, regardless of the specific type, is an attractive treatment option.…”

Section: Discussionmentioning

confidence: 99%

“…Most widely-used one is vascularized fibular grafts. [9][10][11][12] The fibula, with its corticocancellous bone stock, generous vascular pedicle (one artery and two accompanying veins) is applied for free vascularized bone graft transfer. The potential disadvantages of vascularized fibular grafting are prolonged surgery time, need of microvascular technique, prolonged operative scar, associated donor site morbidity, and heterotopic ossification.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The vascularized fibular grafting is associated with better clinical and radiographic results than non-vascularized fibular grafting in precollapse hips. [9][10][11][12] The rationale of vascular pedicled fibula grafting procedure is based on the following points: decompression of the femoral head diminishes intraosseous pressure like compartment syndrome and improves the interrupted circulation which contributes the disease progression. Excision of the necrotic tissue which inhibits revascularization of the head and filling of the defect created after core with vascular pedicled bone graft is a viable method and supports the subchondral surface and enhances the revascularization process.…”

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confidence: 99%

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Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis

Elmalı¹

2014

Eklem Hastalik Cerrahisi

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82.8'e (dağılım; 62-90) yükseldi. Klinik sonuçlar 18 kalçada (%69) iyi ve mükemmel iken, sekiz kalçada (%31) yeterli ve kötü idi. ARCO evreleme sistemine göre, 26 kalçanın 17'sinde (%65) tatminkar sonuç sağlandı. Ameliyat öncesi evre II olan dört kalçadan ikisi evre III'e, ikisi evre IV'e ilerledi. Ameliyat öncesi evre III olan beş kalça evre IV'e ilerledi ve bu hastalara total kalça artroplastisi uygulandı. Sonuç: Çalışma bulgularımız, kor dekompresyon ve damar pediküllü iliyak kemik greft uygulamasının erken evre FBAN'nin tedavisinde etkili olduğunu göstermektedir. The main predisposing factor was steroid use in 13 patients. All patients were assessed clinically according to the Harris hip score and by radiographs by the Association Internationale de Recherche sur la Circulation Osseuse (ARCO) staging system. Results: The mean follow-up was 36 (range 14 to 62) months. Eleven hips (42%) had stage II and 15 hips (58%) had stage III ANFH. The mean Harris scores increased from 52 (range 31 to 63) to 82.8 (range 62 to 90) after surgery. Based on clinical outcomes, 18 hips (69%) were presented as excellent and good, while eight hips presented fair and poor. According to the ARCO staging system, satisfactory results were provided in 17 (65%) of the 26 hips. Two of four hips at preoperatively stage II progressed to stage III, two other hips to stage IV. Five hips at stage III preoperatively progressed to stage IV and these hips had to undergo hip replacement. Conclusion: Our results suggest that core decompression and the vascular pedicled iliac bone grafting are effective in early stages of ANFH.

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“…Osteonecrosis (ON) is a devastating disease usually leading to hip joint destruction in the third through fifth decades of life (average age, 36 years) [12,34,35,40]. The results of arthroplasty in these patients were considered less than satisfactory, as failure rates up to 20% at a 5 year's follow up were initially reported [38].…”

Section: Introductionmentioning

confidence: 99%

Predictive Role of Cytokine Gene Polymorphisms for the Development of Femoral Head Osteonecrosis

Samara¹,

Kollia

Dailiana³

et al. 2012

Disease Markers

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Introduction: Osteonecrosis (ON) is a multifactorial disease that leads to hip destruction. Lately, much focus has been at femoral head preservation with nonsurgical methods. In this study we examined the polymorphisms of IL-1α, IL-1R, IL-1RA, IL-4Rα, IL-1β, IL-12,γIFN, TGF-β, TNF-a, IL-2, IL-4, IL-6 and IL-10 genes for evaluation of their contribution in ON.Material and methods: DNA was extracted from 112 ON patients and 438 healthy donors. Analysis of the polymorphisms was completed using the PCR-SSP method. Statistical analysis was performed using theχ2test to compare the genotype and allelic frequency distribution.Results: The CT and GA genotypes of the IL-1α(-889) and TNF-a (-238) genes were found higher in the patients (51.8% and 10.8%, respectively) compared to the healthy donors (39.7% and 2.1%, respectively). In TGF-βcodon 25, the G to C polymorphism in the homozygous state was found in 1.8% of the patients and the C allele frequency was 8.9%, whereas the G allele frequency was 91.1%. Also, at the IL-10 (-1082) gene the GG genotype was 16.2% in the controls whereas in the patients was 7.2%.Conclusions: Based on the above, we showed that certain genotypes of the IL-1α, TGF-β, IL-10 and TNF-a genes could be related in the pathogenesis of a complicated disease, such as osteonecrosis. The presence of one of the above mentioned polymorphisms or the simultaneous carriage of more than one may further increase the risk for osteonecrosis, especially in those at high risk, such as patients receiving corticosteroids.

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Treatment of Avascular Necrosis of the Femoral Head With Vascularized Fibular Transplant

Cited by 99 publications

References 21 publications

The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis

Predictive Role of Cytokine Gene Polymorphisms for the Development of Femoral Head Osteonecrosis

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